Healthcare Provider Details

I. General information

NPI: 1447864129
Provider Name (Legal Business Name): RAPHAEL ANTONIO TRAMBLE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18470 W 10 MILE RD STE 200
SOUTHFIELD MI
48075-2603
US

IV. Provider business mailing address

47637 BURLINGAME DR
CHESTERFIELD MI
48047-6028
US

V. Phone/Fax

Practice location:
  • Phone: 313-513-5695
  • Fax: 833-636-6592
Mailing address:
  • Phone: 313-513-5695
  • Fax: 833-636-6592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801099987
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801116311
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: